Former Health Insurance Employee Sentenced for Role in Prescription Fraud Scheme
BIRMINGHAM – A federal judge today sentenced a Midfield woman to four years in prison for her part in a prescription fraud scheme while she worked for a health insurance provider, announced U.S. Attorney Joyce White Vance.
U.S. District Judge C. Lynwood Smith Jr. sentenced ANNETRA POOLE-MOORE, 39, for crimes involving health care fraud, aggravated identity theft and disclosures prohibited by the Health Insurance Portability and Accountability Act (HIPAA). Poole-Moore must report to prison Nov. 10.
Poole-Moore and a co-defendant, Isaac Earl Smith, both pleaded guilty to the charges in November 2009. Smith, of Pleasant Grove, is serving a six-year prison sentence for the crimes. Together, the defendants must pay $72,746 in restitution to the Federal Employees Health Benefit Plan.
Between September 2008 and April 2009, Poole-Moore and Smith engaged in a criminal conspiracy to commit health care fraud that resulted in HIPAA violations and aggravated identity theft. During that time, according to court records, Poole-Moore was employed by United Healthcare Inc. as a claims representative associate. In that position, she had access to personal and identifying information on people enrolled in Flexible Spending Accounts administered by United Healthcare.
Without the company’s authorization, Poole-Moore and Smith accessed United Healthcare’s electronic database and obtained the personal information of people who were covered by a prescription drug plan sponsored by the Federal Employees Health Benefit Plan, according to court records. They used the information to create counterfeit prescriptions which were presented to pharmacies to illegally obtain controlled substances. Those drugs were then sold illegally to third parties.
By using stolen identities on the prescriptions, the defendants caused FEHBP’s prescription drug plan to pay for the controlled substances, causing FEHBP to lose $72,746.
“It’s bad enough that Ms. Poole-Moore and her co-defendant schemed to illegally obtain and sell prescription drugs, but they also used stolen identities to cause insurance plans to pay for the cost of these drugs,” Vance said. “Abuse of prescription drugs is a large and growing problem. This office remains dedicated to prosecuting individuals who illegally distribute the drugs, as well as those who cause fraudulent submission of insurance claims, which result in higher insurance premiums for us all,” she said.
The U.S. Postal Inspection Service, the Food and Drug Administration, Office of Criminal Investigations, the U.S. Secret Service, the Office of Personnel Management, and the Montevallo Police Department investigated the case. Assistant U.S. Attorney Lloyd Peeples prosecuted the case.
